Global Economic Intersection
Advertisement
  • Home
  • Economics
  • Finance
  • Politics
  • Investments
    • Invest in Amazon $250
  • Cryptocurrency
    • Best Bitcoin Accounts
    • Bitcoin Robot
      • Quantum AI
      • Bitcoin Era
      • Bitcoin Aussie System
      • Bitcoin Profit
      • Bitcoin Code
      • eKrona Cryptocurrency
      • Bitcoin Up
      • Bitcoin Prime
      • Yuan Pay Group
      • Immediate Profit
      • BitQH
      • Bitcoin Loophole
      • Crypto Boom
      • Bitcoin Treasure
      • Bitcoin Lucro
      • Bitcoin System
      • Oil Profit
      • The News Spy
      • Bitcoin Buyer
      • Bitcoin Inform
      • Immediate Edge
      • Bitcoin Evolution
      • Cryptohopper
      • Ethereum Trader
      • BitQL
      • Quantum Code
      • Bitcoin Revolution
      • British Trade Platform
      • British Bitcoin Profit
    • Bitcoin Reddit
    • Celebrities
      • Dr. Chris Brown Bitcoin
      • Teeka Tiwari Bitcoin
      • Russell Brand Bitcoin
      • Holly Willoughby Bitcoin
No Result
View All Result
  • Home
  • Economics
  • Finance
  • Politics
  • Investments
    • Invest in Amazon $250
  • Cryptocurrency
    • Best Bitcoin Accounts
    • Bitcoin Robot
      • Quantum AI
      • Bitcoin Era
      • Bitcoin Aussie System
      • Bitcoin Profit
      • Bitcoin Code
      • eKrona Cryptocurrency
      • Bitcoin Up
      • Bitcoin Prime
      • Yuan Pay Group
      • Immediate Profit
      • BitQH
      • Bitcoin Loophole
      • Crypto Boom
      • Bitcoin Treasure
      • Bitcoin Lucro
      • Bitcoin System
      • Oil Profit
      • The News Spy
      • Bitcoin Buyer
      • Bitcoin Inform
      • Immediate Edge
      • Bitcoin Evolution
      • Cryptohopper
      • Ethereum Trader
      • BitQL
      • Quantum Code
      • Bitcoin Revolution
      • British Trade Platform
      • British Bitcoin Profit
    • Bitcoin Reddit
    • Celebrities
      • Dr. Chris Brown Bitcoin
      • Teeka Tiwari Bitcoin
      • Russell Brand Bitcoin
      • Holly Willoughby Bitcoin
No Result
View All Result
Global Economic Intersection
No Result
View All Result

The Cost of a Cure: Medicare Spent $4.5 Billion on New Hepatitis C Drugs Last Year

admin by admin
April 6, 2015
in Uncategorized
0
0
SHARES
4
VIEWS
Share on FacebookShare on Twitter

Special Report from ProPublica

by Charles Ornstein, ProPublica

This story was co-published with the Washington Post.

Medicare spent $4.5 billion last year on new, pricey medications that cure the liver disease hepatitis C — more than 15 times what it spent the year before on older treatments for the disease, previously undisclosed federal data shows.

The extraordinary outlays for these breakthrough drugs, which can cost $1,000 a day or more, will be borne largely by federal taxpayers, who pay for most of Medicare’s prescription drug program. But the expenditures will also mean higher deductibles and maximum out-of-pocket costs for many of the program’s 39 million seniors and disabled enrollees, who pay a smaller share of its cost, experts and federal officials said.

The spending dwarfs the approximately $286 million that the program, known as Part D, spent on earlier-generation hepatitis C drugs in 2013, said Sean Cavanugh, director of Medicare and deputy administrator at the Centers for Medicare and Medicaid Services (CMS).

The most-discussed of the new drugs, Sovaldi, which costs $84,000 for a 12-week course of treatment, accounted for more than $3 billion of the spending. Spending on another drug, Harvoni, hit $670 million even though it only came on the market only in October. Bills for a third drug, Olysio, often taken in conjunction with Sovaldi, reached $821 million.

Medicare also spent $157 million on older hepatitis C drugs in 2014, bringing the total spending for the category to more than $4.7 billion.

The spending surge is unlike anything Part D has seen. The nine-year-old program has benefited in recent years from a slowdown in prescription drug costs as several blockbusters, including the cholesterol-lowering drug Lipitor and the blood thinner Plavix, have lost patent protection and have faced competition from generics.

The new hepatitis C drugs, along with other expensive specialty medications in the pipeline, threaten to drastically increase the program’s costs. The federal government spent $65 billion on Part D in 2013, according to the Medicare Payment Advisory Commission. That figure doesn’t include monthly premiums paid by patients.

An analysis published last year on the website of the health-policy journal Health Affairs suggested that 350,000 Medicare beneficiaries have hepatitis C, although many don’t know it. That figure is expected to increase as Baby Boomers, the group with the highest prevalence of hepatitis C, become eligible for Medicare.

It generally takes the government more than a year to compile data on drug spending, but CMS provided the data on hepatitis C drugs to ProPublica in response to a Freedom of Information Act request and follow-up inquiries.

Medicare officials said they are watching the costs carefully, and early indications suggest that this year’s spending is on track to match or even exceed last year’s, Cavanaugh said.

He said in an interview:

“We’re all waiting to see when it plateaus or when it possibly goes back down. When will that pent-up demand be sated?”

Medicare’s costs for the drugs, at least in 2014, appear to be far higher than those incurred by state Medicaid programs for the poor, which collectively spent $1.2 billion on the drugs in the first nine months of the year. (This data is preliminary; data for the entire year is not yet available.)

Many Medicaid programs, as well as private insurance companies, took a more restrictive approach toward the drugs than Medicare did, often requiring that patients have advanced liver disease to be eligible to receive the pills.

Medicare has a more permissive standard, requiring the insurance companies that administer Part D on its behalf to cover medically necessary drugs for any indication approved by the Food and Drug Administration or recommended in clinical guidelines.

The new hepatitis C drugs have a higher cure rate — 90 percent or higher — than previous treatments, as well as fewer harmful side effects. Some studies have shown that, despite their price tag, the drugs justify their cost based on the better quality of life they provide and the health expenses that patients avoid in the future.

A liver specialist at the University of Miami Health System in Florida, who prescribed $13.5 million worth of hepatitis C drugs in Part D last year, Dr. Adam Peyton said:

“Curing hepatitis C will likely go on to prevent liver cancer, go on to prevent patients needing liver transplantation, go on to save health care dollars down the road. It’s upsetting that there’s been so much negative publicity for such a positive breakthrough in medicine.”

Still, the drugs may not save money for Medicare, even in the long run. A recent study in the Annals of Internal Medicine suggested that only about one-quarter of the $65 billion needed to pay for the new drugs for eligible patients (not just those on Medicare) would be offset by avoiding hospitalizations and other treatment costs. The vast majority of patients with hepatitis C don’t go on to get liver transplants.

Federal taxpayers cover the preponderance of the cost of treating patients in Part D, but enrollees also have to pick up a share, which can vary based on their drug usage. Once a Medicare enrollee spends $4,700 out of pocket on drugs — in this case, just a few days of a prescription — “catastrophic” coverage kicks in. At that point, Medicare picks up 80 percent of the cost, the health plan pays 15 percent, and the patient pays the remaining 5 percent.

Some costs probably will be passed along to Medicare beneficiaries who don’t have hepatitis C, in the form of higher deductibles and maximum out-of-pocket costs, said Jack Hoadley, a research professor in the Health Policy Institute at Georgetown University.

For example, next year the standard drug deductible in the program — the amount a patient has to spend before coverage kicks in — will increase to $360 from $320.

The out-of-pocket maximum, at which catastrophic coverage begins, is also going up to $4,800 from $4,700. Beyond that, insurance company premiums may also increase somewhat, though increases could be offset by changes in the use of other drugs. Rates have not yet been announced for 2016.

Sen. Bernie Sanders, a Vermont independent, has been a critic of the high price of the new drugs, particularly Sovaldi.

Sanders said in a written statement to ProPublica:

“The cost of Sovaldi is not only an economic issue in terms of the impact of the cost of this drug on the VA, on Medicaid, on Medicare, it is a moral issue, and that is how many people in this country will suffer, how many will die very painful deaths because of the excessive costs of this particular product.”

This year an additional competitor has come on the market, the Viekira Pak made by AbbVie, giving insurance companies leverage to negotiate larger rebates in exchange for a spot on their preferred-drug lists. Those rebates can slice 40 percent to 50 percent off the list prices of the drugs.

The law that created Medicare Part D does not allow the government to negotiate rebates directly, but it allows the private insurance companies that administer the program to do so. Details on the rebates are confidential.

Gilead Sciences, the maker of Sovaldi and Harvoni, has defended its prices, saying they are fair given the value the drugs provide to patients. In a statement, the company said it has

“established one of the most comprehensive patient assistance programs in the industry to help ensure cost is not a barrier to Sovaldi and Harvoni for patients in the U.S. with high co pays or who lack adequate insurance.”

Medicaid experts acknowledge that anticipated legal challenges may compel state Medicaid programs to stop rationing the new drugs.

Many states have held back because they felt “held completely captive to [Gilead’s] pricing,” said Matt Salo, executive director of the National Association of Medicaid Directors.

“There’s a sense, it’s pretty broadly shared, that that’s not going to be a sustainable policy for long.”

With the emergence of the new drugs, a new set of doctors has moved to the head of the list of Medicare Part D’s top prescribers by dollar amount.

Dr. Bruce Bacon, a liver specialist at St. Louis University, will likely be ranked No. 1 for drug spending in Part D in 2014, federal data shows. He wrote 925 prescriptions for hepatitis C medications, costing $22 million. By contrast, the program’s top prescriber in 2012 wrote 76,000 prescriptions that cost $10.5 million.

Bacon said he had no idea that his prescriptions cost Medicare so much money.

He said:

“I really don’t think about the cost. I think about taking care of the patients. Should I not take care of the patients because the cost is expensive?”

Like many of the most prolific prescribers of the new drugs, Bacon has received speaking fees from Gilead Sciences and Janssen Pharmaceuticals, the maker of Olysio. He said he and many experts have relationships with several companies. “It doesn’t make a difference at all” in prescribing, he said.

Medicare patients with hepatitis C recognize how much the drugs cost, but say the results have changed their lives.

Robert Serrano, 61, one of Peyton’s patients, who said he is on Medicare because he is disabled, said Sovaldi cured him. He had a liver transplant in October 2008 but the disease had started to attack his new liver.

He said:

“It was a long road for me with this condition that I had and the medications. Now at least I’m able to cut grass and do the little things I didn’t do in life. It’s been a blessing.”

ProPublica data reporter Ryann Grochowski Jones contributed to this report.

Use our Prescriber Checkup tool to compare your doctor’s prescribing patterns to others in the same specialty and state.

ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for their newsletter.

Previous Post

06Apr2015 Market Close: DOW Closed Up Triple Digits, U.S. Dollar Recovers And The Oils Rise To New Near-Term Highs

Next Post

6 April 2015 Weather and Climate Outlook – Weekend Computer Revolt – SOI Reverses

Related Posts

Hong Kong Securities Watchdog Hires Crypto Personnel For Sector Supervision
Business

Hong Kong Securities Watchdog Hires Crypto Personnel For Sector Supervision

by John Wanguba
February 6, 2023
Hindenburg Bet Against India's Adani Baffled Rival U.S. Short Sellers
Business

Hindenburg Bet Against India’s Adani Baffled Rival U.S. Short Sellers

by John Wanguba
February 6, 2023
Volvo Prepares EV Blitz In Biggest Product Revamp Under Geely
Business

Volvo Prepares EV Blitz In Biggest Product Revamp Under Geely

by John Wanguba
February 6, 2023
Luxury Rehab Center Comes Up Offering ‘Crypto Addiction’ Therapy
Business

Luxury Rehab Center Comes Up Offering ‘Crypto Addiction’ Therapy

by John Wanguba
February 6, 2023
Alphabet Disappointed On Sales As Ad Revenue Plunged After Pandemic Run-Up
Business

Alphabet Disappointed On Sales As Ad Revenue Plunged After Pandemic Run-Up

by John Wanguba
February 6, 2023
Next Post

07Apr2015 Pre-Market Commentary: Markets Expected To Open In The Green, U.S. Dollar Rising, WTI And Brent Oil Falling

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

Browse by Category

  • Business
  • Econ Intersect News
  • Economics
  • Finance
  • Politics
  • Uncategorized

Browse by Tags

adoption altcoins banking banks Binance Bitcoin Bitcoin adoption Bitcoin market Bitcoin mining blockchain BTC business China crypto crypto adoption cryptocurrency crypto exchange crypto market crypto regulation decentralized finance DeFi Elon Musk ETH Ethereum Europe finance FTX inflation investment market analysis markets Metaverse mining NFT nonfungible tokens oil market price analysis recession regulation Russia technology Tesla the UK the US Twitter

Archives

  • February 2023
  • January 2023
  • December 2022
  • November 2022
  • October 2022
  • September 2022
  • August 2022
  • July 2022
  • June 2022
  • May 2022
  • April 2022
  • March 2022
  • February 2022
  • January 2022
  • December 2021
  • November 2021
  • October 2021
  • September 2021
  • August 2021
  • July 2021
  • June 2021
  • May 2021
  • April 2021
  • March 2021
  • February 2021
  • January 2021
  • December 2020
  • November 2020
  • October 2020
  • September 2020
  • August 2020
  • July 2020
  • June 2020
  • May 2020
  • April 2020
  • March 2020
  • February 2020
  • January 2020
  • December 2019
  • November 2019
  • October 2019
  • September 2019
  • August 2019
  • July 2019
  • June 2019
  • May 2019
  • April 2019
  • March 2019
  • February 2019
  • January 2019
  • December 2018
  • November 2018
  • October 2018
  • September 2018
  • August 2018
  • July 2018
  • June 2018
  • May 2018
  • April 2018
  • March 2018
  • February 2018
  • January 2018
  • December 2017
  • November 2017
  • October 2017
  • September 2017
  • August 2017
  • July 2017
  • June 2017
  • May 2017
  • April 2017
  • March 2017
  • February 2017
  • January 2017
  • December 2016
  • November 2016
  • October 2016
  • September 2016
  • August 2016
  • July 2016
  • June 2016
  • May 2016
  • April 2016
  • March 2016
  • February 2016
  • January 2016
  • December 2015
  • November 2015
  • October 2015
  • September 2015
  • August 2015
  • July 2015
  • June 2015
  • May 2015
  • April 2015
  • March 2015
  • February 2015
  • January 2015
  • December 2014
  • November 2014
  • October 2014
  • September 2014
  • August 2014
  • July 2014
  • June 2014
  • May 2014
  • April 2014
  • March 2014
  • February 2014
  • January 2014
  • December 2013
  • November 2013
  • October 2013
  • September 2013
  • August 2013
  • July 2013
  • June 2013
  • May 2013
  • April 2013
  • March 2013
  • February 2013
  • January 2013
  • December 2012
  • November 2012
  • October 2012
  • September 2012
  • August 2012
  • July 2012
  • June 2012
  • May 2012
  • April 2012
  • March 2012
  • February 2012
  • January 2012
  • December 2011
  • November 2011
  • October 2011
  • September 2011
  • August 2011
  • July 2011
  • June 2011
  • May 2011
  • April 2011
  • March 2011
  • February 2011
  • January 2011
  • December 2010
  • August 2010
  • August 2009

Categories

  • Business
  • Econ Intersect News
  • Economics
  • Finance
  • Politics
  • Uncategorized
Global Economic Intersection

After nearly 11 years of 24/7/365 operation, Global Economic Intersection co-founders Steven Hansen and John Lounsbury are retiring. The new owner, a global media company in London, is in the process of completing the set-up of Global Economic Intersection files in their system and publishing platform. The official website ownership transfer took place on 24 August.

Categories

  • Business
  • Econ Intersect News
  • Economics
  • Finance
  • Politics
  • Uncategorized

Recent Posts

  • Hong Kong Securities Watchdog Hires Crypto Personnel For Sector Supervision
  • Hindenburg Bet Against India’s Adani Baffled Rival U.S. Short Sellers
  • Volvo Prepares EV Blitz In Biggest Product Revamp Under Geely

© Copyright 2021 EconIntersect - Economic news, analysis and opinion.

No Result
View All Result
  • Home
  • Contact Us
  • Bitcoin Robot
    • Bitcoin Profit
    • Bitcoin Code
    • Quantum AI
    • eKrona Cryptocurrency
    • Bitcoin Up
    • Bitcoin Prime
    • Yuan Pay Group
    • Immediate Profit
    • BitIQ
    • Bitcoin Loophole
    • Crypto Boom
    • Bitcoin Era
    • Bitcoin Treasure
    • Bitcoin Lucro
    • Bitcoin System
    • Oil Profit
    • The News Spy
    • British Bitcoin Profit
    • Bitcoin Trader
  • Bitcoin Reddit

© Copyright 2021 EconIntersect - Economic news, analysis and opinion.

en English
ar Arabicbg Bulgarianda Danishnl Dutchen Englishfi Finnishfr Frenchde Germanel Greekit Italianja Japaneselv Latvianno Norwegianpl Polishpt Portuguesero Romanianes Spanishsv Swedish